THE LARYNX

Learning Objectives:

1. Describe the functions of the larynx.

2. Describe its structure, sensory innervation, blood supply and lymphatic drainage.
3. Describe the intrinsic and extrinsic laryngeal muscles including their actions and
innervation.
4. Swallowing (Done in the Pharynx Lecture)

• The larynx has several functions. The primary one is to protect the lower
respiratory tract from entry of foreign bodies through its sphincteric action at the
region of the laryngeal inlet. The secondary functions are for phonation,
whispering, coughing, sneezing and certain muscular efforts such as lifting and
evacuation of the pelvis.

• The skeleton of the larynx is composed of a) cartilaginous and b) Fibrous

components. The fibrous part is either membranous or ligamentous. The
cartilaginous component consisted of the following:

1. one cricoid cartilage

2. one thyroid cartilage
3. two arytenoid cartilages
4. one epiglottic cartilage

• The cricoid, thyroid and arytenoids cartilages are hyaline cartilage. The epiglottic
cartilage is a yellow cartilage. This is important because hyaline cartilage tends to
calcify and often ossify in old age. The epiglottis could not function if it is
calcified.

• The movements of the arytenoid cartilages are critical in laryngeal function.

There are synovial joints between these cartilages. The thyroid and cricoid
cartilages can move forward and backward around the cricothyroid joints. Above
the apical processes of the arytenoid cartlages are small corniculate cartilages.
Laterally, in the aryepiglottic folds are cuneiform cartilages. These cartilages
provide support to the aryepiglottic folds.

• There are three membranes attached to thyroid and cricoid cartilages. The first
one is the thyrohyoid membrane that connects the upper margin of the thyroid
cartilage to the hyoid bone. It is pierced by the laryngeal vessels and the internal
laryngeal nerve. The second one is the cricothyroid membrane (ligament) that
attached below to the cricoid cartilage. Above, instead of being attached to the
lower margin of the thyroid cartilage, it goes upward on the medial surface of the
cartilage. The upper margin forms the vocal ligament on each side. The vocal
ligament forms the interior of the vocal folds. The anterior end of each vocal cord
is attached to the thyroid cartilage and the posterior end is attached to the vocal

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 process of the arytenoid cartilage. In the clinics, they refer to the vocal folds as
the vocal cords. They look white in life. The space between the vocal folds is
called the rima glottidis. It is the entrance to the lower respiratory tract. The third
membrane is superior to the cricothyroid membrane. It is the quandrangular
membrane, which is thin and passes down from the epiglottis and attached to the
apical process of the arytenoid cartilage and also to the thyroid cartilage. The
lower borders of the quadrangular membrane are free and slightly thickened. They
form the vestibular ligaments. They are covered with mucosa and is known as
vestibular folds. In the clinics, they refer to the vestibular folds as the false
vocal cord.

• In between the vocal and vestibular ligaments, the mucosa herniates. The opening
of the hernia is called the sinus and the inside of it is called the saccule. Mucous
glands inside the saccule moisten the vocal folds and prevent damage. The cavity
situated between the inlet and the vestibular folds is called the vestibule. The
cavity between the vocal folds and the lower border of the cricoid cartilage is
known as the infraglottic compartment.

• The muscles of the larynx are divided into extrinsic and intrinsic groups. The
extrinsic group are responsible for the movement of the whole larynx whereas the
intrinsic group is responsible with the movement of the parts of the larynx. The
extrinsic muscles that elevates the larynx are the digastric, stylohyoid, mylohyoid,
geniohyoid, stylopharyngeus, salphingopharyngeus and palatopharyngeus
muscles. They move the larynx up during swallowing. The extrinsic muscles that
depress the larynx are the sternothyroid, sternohyoid and omohyoid.

• The intrinsic muscles are divided into two types namely those that modify the
laryngeal inlet and those that act on the vocal cords. For the former type, they are
the following:

1) Aryepiglottic muscle: These muscles run on the upper border of the

quandrangular membrane and down the aryepiglottic fold. Attachments:
Side of the epiglottis to the apical process of the arytenoids.
Action: Narrowing of the inlet.

2) Oblique arytenoids: These muscles pass from the muscular process of the
arytenoids of one side to the apical process of the other side. Action:
Narrowing of the inlet.

3) Thyroepiglottic muscle: These pass from the upper border of the thyroid
cartilage and runs upwards to the side of the epiglottis. Action: It pulls the
epiglottis down.

• Nos. 1 and 2 are one muscle.

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 tracheostomy = at trachea/ crico-thyroid membrane ( )

• The muscles that act on the vocal folds are the following:

1) Posterior cricoarytenoid muscle: These are the only muscle that open the
vocal folds in order to breathe. They need to work constantly to keep the
airway open otherwise the folds adduct. They run from the whole of the
back of the lamina of the cricoid cartilage to the muscular border of the
arytenoids. Action: Abduction.

2) Lateral cricoarytenoid: These run from the upper part of the cricoid
cartilage internally to the thyroid laimna to insert into the muscular
process of the arytenoid. Action: Adduction.

3) Transverse arytenoids muscle: These span the gap between the apical
processes of the arytenoids cartilage. Action: Approximates the
arytenoids. closes rima glottis

4) Cricothyroid muscle: They are anterior, passing from the upper border of
the arch of the cricoid to the lower border of the thyroid laminae. Action:
Tenses the vocal folds.

5) Thyroarytenoid muscle: These run from the inside of the thyroid lamina
back to the muscular processes of the arytenoids. They are lateral to the
vocal ligaments. Action: Shorten the vocal folds.

6) Vocalis muscle: These fibers are just lateral to the vocal ligaments,
between the thyroarytenoid muscle and the ligaments and insert into the
ligaments themselves. Action: Tense the cord and bring the edges of
the vocal folds upward during abduction.
pierce TH membrane
• The sensory nerve supply above the vocal folds is from the internal laryngeal
nerve. This nerve is a branch of the superior laryngeal nerve of the vagus nerve.
Below the vocal folds is supplied by the recurrent laryngeal nerve, which is a
branch of the vagus nerve arising from the thorax. ILN = Sensory
ELN = Motor (to CT
• The motor nerve supply for the intrinsic muscles of the larynx is all from the
recurrent laryngeal nerve except for the cricothyroid muscle, which is supplied
by the external laryngeal nerve. This nerve is a branch of the superior laryngeal
nerve of the vagus nerve.

• The blood supply is from the superior and inferior laryngeal arteries. These
are branches of superior and inferior thyroid arteries respectively. The laryngeal
veins accompany the arteries and eventually drain into the internal jugular veins.
The lymphatic drainage superior to the vocal folds drains into the superior deep
cervical nodes and below the vocal folds to the inferior deep cervical nodes.

/GLTIPOE-06
superior thyroid -- 1st branch of External carotid A
inferior thyroid -- thyrocervical trunk. 1st subclavian A
https://www.slideshare.net/DrSherifFahmy/the-larynx-anatomy-of-the-neck
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